Dr. Thanh Neville is a junior faculty member in the Division of Pulmonary and Critical Care at UCLA who has the long-term goal of using research to improve the quality and appropriateness of care in the intensive care unit (ICU). Her career objective is to become an independent investigator and an academic leader in aging and critical care research. She is currently mentored by Dr. Neil Wenger, who is a well-known health services researcher and the Director of the UCLA Ethics Center. She also has a multi-disciplinary team of well-qualified co-mentors and advisors who will each provide direction in qualitative analysis, statistical modeling, aging research, and intervention development and implementation. Formal courses at UCLA in qualitative methods, aging, implementation science, and biostatistics will complement the guidance she receives from her mentors. She is strongly supported by her division and will be performing her research at UCLA, an institution renowned for its academic, clinical, and research excellence. In this proposal, Dr. Neville seeks to characterize the factors related to older patients receiving inappropriate treatment in the ICU and how physician behavior and system-wide practices might be changed to transition such treatment toward appropriate palliative care. Older patients are the largest growing subset of patients requiring care in the ICU and are vulnerable to the harmful effects of the mismatch of treatment to prognosis. Inappropriate treatment, defined here as a treatment that should not be provided because it does not offer the patient benefit, can prolong suffering, cause family distress, and transform death into an undignified process. This project builds on Dr. Neville's work in defining and quantitating inappropriate treatment in the ICU. It explores and analyzes a previously completed medical record abstraction that she has collected on patients who received inappropriate treatment, patients who received probably inappropriate treatment, and patients who did not receive inappropriate treatment in the ICU. The goal of the proposed project is to 1) use qualitative and quantitative methods to explore the patient, physician, communication, and structural factors related to provision of inappropriate ICU treatment for older critically ill patients, 2) develop and validate a prospective tool to identify patients at rsk of inappropriate treatment at entry into the ICU, and 3) develop and pilot an intervention to decrease inappropriate treatment in the ICU. This application will be a step toward developing interventions that successfully reorient critical care when the prognosis is poor.